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An Open Letter to Dr.s About Pain Management

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Dear Doctors:

Knowing that you’re medical practitioners, you should understand, clearly,the difference between dependence and addiction. One can be dependent on a medication without being addicted to it. It’s also possible to be addicted to a medication and not actually be physically dependent upon it (psychological dependence is a given).

That said, I am dependent upon the medication I take for heart rate control for my pulmonary arterial hypertension. If I were to stop taking the medication abruptly, there is a small chance I could die. I could have high blood pressure for a short time after coming off it abruptly, and there’s a warning that abruptly stopping it could cause a heart attack. Doctors have to wean the patient off the medication slowly to avoid these problems, even when the patient exhibits no need for the medication any longer.

The prednisone I take, I am dependent upon. The prednisone, when taken at higher doses for long periods of time will shut down the adrenal glands. If you simply stop taking it, you can go into adrenal crisis and you could die. To prevent this, when doctor’s take a long-term prednisone patient off this medication, they wean them down, VERY slowly, sometimes over the period of a year or longer, one milligram dosages at a time, until the patient’s adrenal glands kick back in again (assuming they even do).

But I am not addicted to my heart rate medication. I am not addicted to prednisone cialis kaufen schweiz. I am dependent upon both of them, absolutely. That all said, doctors hand out medication like this, medications that cause dependency in the body (all anti-depressants, all blood pressure medications, most heart medications in general, all immune-modifying or immune-suppressing medications) like candy to patients without a second thought.

But don’t tell a doctor you have pain. There is no ‘candy’ for that.

PAIN MANAGEMENT IS A JOKE IN AMERICA

After a year of seeing a doctor for conditions we had difficulty pinpointing, she worked with me to find solutions for my pain. Pain was one of the most important symptoms I had to her, because in her mind, it was a warning that something was going on and she wanted to find it. In the meantime, she also wanted me not to be in pain. I had been a good patient. I’d come to my appointments regularly. I was intelligent and communicated well with her. She believed me when I told her I was in pain, and the thermography and sonography showed the inflammation and cold spots that could potentially cause pain. She prescribed non-narcotic medications to try to help with the pain, but not knowing the cause made that difficult. I have tried Neurontin, Cymbalta, Savella, Lyrica, amitriptyline, Zipsor, Cellebrex, Lodine, Nuvigil, and steroids. I probably have tried others, just can’t think of them. Neurontin/gabapentin works for the sciatica I have from the twisted back, but doesn’t help with the other pain. None of the others helped with the pain at all (except the steroids helped moderately, but not enough to make them worth it just for pain relief).

So she gave me Vicoprofen. Some of you might know the name as Lortab, Narcon or Vicodin, or the generic hydrocodone. This usually comes with Tylenol in it, but because of my inflammation, she gave it to me with ibuprofen. It was like a miracle drug for me. Not because it made me stoned. Not because I got a high or a low or an affect off of it, but because it managed to make my pain go away.

My doctor, who had a relationship with me, knew me and trusted me, gave me 120 pills at a time, because it was much, much cheaper to buy it this way. 20 pills cost about $60 bucks. 120 pills at Wally World cost me about $98 bucks. HUGE difference. I would take 1/2 to 1 1/2 pills per day, maximum, and on really good days, might not take any at all. She prescribed it so I could take one to two pills ever four to six hours, but I never needed that much.

Then I got sick. I ended up in the hospital for a week on the monitors and all that jazz, and in the meantime, my primary care doctor moved to an urgent care center and was no longer doing primary care. I loved the doctors I’d met while in the hospital, so I switched my care over to UTMB. I started seeing their specialists there, but none of them would prescribe my pain meds for me. They didn’t have a relationship with me. They didn’t know me. They didn’t trust me. Even if they did, they have an across the board policy that they can only prescribe long-term, non-acute pain medication through their pain management clinic, and you have to be referred to that and wait to get approved, after you have all the imaging done for them to prove you need pain meds. Once they approve you, then you have to go to the clinic on a regular basis, bringing your medication with you. They urine test you to make sure you’re taking the meds you’re supposed to be taking, and other indignant things such as this.

So that people who are in pain must be treated like they are potential criminals in order to alleviate their pain.

How is this right? Just because a few bad apples do bad things with pain meds, we have to be treated like criminals to be treated for our pain? Do you know how much more money it costs to send us to pain management clinics and make us come in for app… ohhhhhh…. I see.

I understand now.

It’s all about the money, isn’t it?

My doctor trusted me, and while she wanted to make money, she was more about treating me as a patient. She prescribed meds for me that I needed, followed up with me about my pain needs, and never made me go to extra appointments or other things in order to keep my meds that worked for me. She treated my pain meds exactly the same way she treated the PHA meds, the thyroid meds, etc.

But no, the clinics can make more money if they require you to make an appointment every so often to keep your meds, you have to pay for a piss test to prove you’re not dealing and selling meds, and you have to account for all your medication every appointment, and if you’re not taking enough of it, they assume you don’t need it and take you off of it–have any of you ever had to do that with your heartburn meds? How would you feel if your doctor made you come in once per month and pee in a cup in order to continue to get your blood pressure medication, or your heartburn medication, or your thyroid medication, when you knew it wasn’t necessary to do that test in order to see if the medication was working for you? Just to see if you were actually taking it.

How would you feel if you were made to come to EXTRA appointments to monitor the use of your medication for your diabetes, and you had to pay for that appointment just for the medication as well as paying for the appointment with the doctor for the condition that causes you to need the medication too? Double the cost. Double the visits (when it’s hard enough for someone in pain to get to one appointment, much less two for the same condition) and double the hassle.

Maybe it really is all about money behind the ‘safety’ schemes they say. I also know the government has a hand in it too, making it harder for doctors who have to justify why they are prescribing these meds.

So really, the government treats the doctors like they’re criminals and the doctors treat the patients like they are criminals, and in the end, the only ones who aren’t given a hard time, the only ones who can get the drugs easily and without any hassle, are the actual criminals.

So doctors, think about what you’re doing and the message you’re sending to your patients. You’re saying you don’t trust them when you won’t treat their pain. You’re sending a subconscious message to your patient that you don’t really believe they are in pain, which makes the patient not trust you. Consider that pain is truly a symptom and like any other symptom it should be treated. Pain is proven to be one of the most debilitating, complex symptoms a patient can have, and it’s been proven when that is adequately treated, patients tend to do better in all other aspects of their treatment. Patients whose pain is managed appropriately in the hospital tends to heal faster and go home sooner. Patients whose pain is managed appropriately tend to have better outlooks on life, respond better to other medications, emotionally handle their illnesses better, are more active in participating in their health management, and so many other things. There has been study after study to prove this.

Quit being afraid to be doctors. Quit being afraid to prescribe the medication that you know your patient needs. Quit looking at every patient who comes to you with pain as though they are trying to play the system and actually treat them. Find the cause of their pain. I assure you, if you find and treat the cause, your patient won’t want ‘pain pills’–what the majority of patients with chronic pain want is for the pain to stop! Make it stop! Be a doctor and find and treat the cause and make it stop and you can keep your pain pills for yourself.

But until you do, manage my pain. Manage our pain. It’s the single worst symptom I deal with, including not being able to breathe well all the time. I’d rather be out of pain and on oxygen for the rest of my life than to breathe normally again and still have pain. There is a lot I would trade to be out of pain. As Dr. House said, “Pain makes us make bad choices….”

So no, doctors, I’m not an addict, but sadly, you have me thinking like one. I’m counting my pills, wondering how long they will last. I’m already thinking about my next appointment and what I have to do and say to ensure you won’ take my pain medication away. I’m already devising plans to come up with a way to get pain pills from some source if you were to ever cut me off. I’m seeking alternative routes to ‘get my fix’. I do this every time my pain medication prescription comes close to an end. This from a woman who takes maybe 1/2 a pill per day most days. But without that half a pill, my life would be VERY different. I know. I’ve been there, and I don’t want to go back.

I’m not addicted to the pain pills, doctor. I’m not even dependent upon them. MOST of us out there in pain management aren’t.

What we’re addicted to is the feeling you might take for granted, doctor–pain free. We don’t get to do that any more. Don’t treat us like we’re junkies. It’s not the pills we want. We want the pain to stop.

Love and stuff,

Michy

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8 Responses to “An Open Letter to Dr.s About Pain Management”

  1. I have the opposite experience. Usually they will prescribe pain pills for me and I don’t want them. I bet if I did have chronic pain and needed them *poof* those pills would dry up.

    Do you have to just see the doctors there or can you see them for some of your conditions but still see your old doc for the pain?

    • Michy says:

      My old doc has moved from the family practice clinic to an urgent care center. Because of federal regulations, her urgent care center limits pain medication to 20 pills/dosages per patient, per acute condition, then refers to pain management or a primary care doctor for additional treatment. As such, she can no longer write prescriptions for long-term pain management. (pout) She’s actually not a doc; she’s a PA, and she has to work under a doc who manages her, so she’s stuck unable to help me.

  2. Farah says:

    I don’t have any personal experience with such things, and of course, I don’t even live in the States (yet), but I would like to say that the situation those doctors put you in is quite ridiculous. It’s so unheard of, I sometimes wonder how this kind of treatment even flies in America. Here, it’s very professional and straight to the point. I don’t think we have as much politics involved, though I wouldn’t say it’s completely void of it, but still there is more integrity in the medical industry compared with there.

    I think more people should read this and share their opinions/experiences. It’s an eye opener for just about anyone really.

    (((HUGZ))) Stay strong, and I wish all your pains would just go away so you won’t need to go through all this.

  3. Derek Odom says:

    E has a LOT of experience in this; you are right: it’s sad the way things are done, Michelle.

  4. GFM says:

    Pretty nice post. I just stumbled upon your blog and wanted to say that I’ve really enjoyed browsing your blog posts. After all I’ll be subscribing to your rss feed and I hope you write again soon!

  5. Julie says:

    As we say in England – spiffing! Thankyou!

  6. Sardonic Sandy says:

    Heres what I don’t understand.

    Doctors who are just dying and will ultimately stamp the two big letters “D” and “F” on your forehead.

    D= “Depression” (clinical or bi-polar)
    F= “fibroidmyalgia”

    What I don’t get is, the bone scans, MRI’s, CT scans, bloodwork, etc etc etc ALL indicate that YES, you’re in pain. I’ve even been called an “enigma” by one Doctor because he said I looked like a million bucks, but he knew I was in excruciating pain.

    I ended up filing with The Attorney General against my Doctor. The returned the favor by retaliating against me & abandoning me. They did to on my med due date, not in writing (in fact I have NEVER received anything in writing saying they’re releasing me) & did not follow protocol which was to refer me to another Doctor who could treat my condition (like I really wanted that so the new Doctor could be biased) and also give me 30 days worth of my meds. Nodda. Nothing. Just fed to the wolves.

    Thus far, I have had 3 seizures (1 resulting on parical facial paralysis) & a handful of other things that have occurred & exacerbated conditions that I already had AND that the treating Doctor and his staff knew about.

    All that mattered to them was punishing me and teaching me to be “grateful” the next time a Doctor writes for meds than enable me to walk and end a lot of suffering. In other words, teach me a lesson that they were doing me a “favor”, not their job. No, its not their job to prescribe narcotics, but they were and did, therefore, they should take the nessessary safety measurements when discontinueing the care of a patient.

    Anyways, I ended up going to see another Doctor. I had every intention on seeing a specific Doctor as she was my original Doctor who left the facility I was at and I trusted her and just now was able to track her down. When I got there that day, I learned I would be seeing someone else.

    Long story short is, immedietly they drug tested me. They didn’t have any of my medical records and hadn’t even spoke with me yet. Narcotics wasn’t even part of my volcab as this point, and they’re testing me? Huh? I brought in some of my meds so they could see what I was taking previously, the dates and see that I don’t abuse them. In fact, I had MORE than I should. I’ll get back to that later.I explained to them that my last Doctor told me to “ration” myself with what I had and “alternate” what I had to make withdrawls easier. So, I followed what they suggested. Now this new Doctor didn’t like what my urine showed.

    My urine showed decreased amounts of Fentanyl and higher amounts of Morphine. Well, that can be explained. I explained why and what my previous Doctor said to do and instead of understanding, I was told I was “hoarding” my medication. Oh boy! Immedietly, the next thing that comes flying out of their mouth was my “Criminal History”. Some bad choices I made 21 years ago. Nothing violent. Nothing to do with prescription drugs either. They insisted that I “hid” this information from their 17 page application when I most certainly DID NOT! But to be clear, had they asked, I would have felt something I did 21 years ago was simply NOT their business nor relevant, especially since it wasn’t violent, not sexual and had nothing to do with drugs. It DID however involved Public Intoxication on my 21st birthday. Utterly ridiculous!

    Now Im being called a LIAR, withholding “evidence” (yes, they actually called it “evidence” in the office) as I was drilled, drilled, drilled! I was then told I was in “denial” about my “history” and in denial about my “clinical depression” and my clinical depression is what is causing my pain!

    What? Huh? I don’t suffer from clinical depression! And I have not had any type of alcoholic beverage in over 15 years, which was 2 years BEFORE I was EVER placed on narcotics for all the things PHYSICALLY ailing me and causing me this much pain.

    Then, the “Doctor” tells me I have 30 days to lose ten pounds (she had to be about 40 lbs heavier than me), make an appnt with a Psychotherapist to start “Intensive Psychotherapy” AND Physical Therapy! All of this in 30 days, all the while I am going through withdrawls and wouldn’t and cannot hardly walk regardless. Again, this “New Doctor” didn’t have ANY of my MRI’s, CT Scans and NO medical history on me. Well, other than what I told her. She determined ALL THIS about me in 12 minutes.

    So this means ALLLLLLLLLLLLLL the Doctors before her, including her boss (my ex-doctor, the one I originally scheduled to see) and all the specialists over the last 13 years were ALL WRONG and it is SHE who is RIGHT! She has single-handedly “diagnosed” my problem and it is only “clinical depression”. She came up with this idea despite me disagreeing. the bloodwork in the past, tests, MRI’s, CT Scans, oncologists, etc etc etc, ALL WRONG and it is SHE, almighty SHE who is RIGHT!

    Well GEE! Had I knew that by simply “talking with a therapist” would have treated my pain and issues, I never ever would have went to see anyone else and never would have taken a narcotic!

    So now, I can what, agree to take anti-depressants and other mental meds (that I don’t need) so they can have me zombied out and re-do my personality? Hooray! Having people mess around and take psychotropic meds who don’t need them is so dangerous! Been there, done that! 1995-1997! Didn’t help my pain! Made me suicidal! Ruined relationships! Oh! And I became “dependant” on those too since you have to be tapered off those as well.

    These quacks amaze me! Seriously!

    Why don’t they just BAN pharmecudical companies and manufacturers who make “pain killers” since everyones pain stems from “depression” and can all be accurately controlled with anti-psychotic” meds then? They’re NOT worried about someone taking these types of meds, who clearly don’t need them, going off the deep end and going postal or suicidal though? Huh? No risk there huh? Studys show that even in persons who NEED these meds have adverse reactions and they become either homicidal or suicidal. But they’re NOT worried about that though! They’re NOT worried that a person sleeps for 14 hours out the day and a ZOMBIE on these “mental meds” all in the name of “combating pain”. Nope, no concern there Doc! These meds don’t provide a “high” or “euphoria” and that’s what they’re sooooooooooo worried about! Someone “liking” their meds and becoming “addicted” or “dependant” but again, if you prescribe lets say Lithium,Depakote,Zyprexa,Haldol,Thorozine,Celexa,Cynaquan,Elevil,Mellerill, etc etc etc etc etc….THOSE meds cannot “suddenly” be stopped either WITHOUT the risk of SOMETHING and that SOMETHING could really and truly result in something seriously dangerous. Especially when a person is taking them for the wrong reason and for something they don’t suffer from.

    Am I upset and depressed NOW? Well, umm, yea! Im in agony! Of course I am! Duh!

    Thanks for letting me vent. Nice page too. Take Care good people. Hope ya can stay pain free…..somehow.

    • Michy says:

      Sandy, you’re so right in that the docs tend to label everything depression or fibromyalgia, even if that’s not what it is. I was so sick of them telling me everything that was going on with me was FM. It certainly wasn’t, and once they had me in the hospital, it was clear that it wasn’t, but for four almost five years, I fought that stigma. I know FM is real for some people–but it wasn’t what was causing MY pain. So easy to just look for the easy stuff, and blow off those who have more complicated issues.

      I’m sorry for all you’ve gone through. I hope you find a good doctor willing to find your cause of pain and treat it.

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